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Labor induction is the procedure where a medical professional starts the process of labor (Childbirth) instead of letting it start on its own. Labor may be induced (started) if the health of the mother or the baby is at risk. Induction of labor can be accomplished with pharmaceutical or non-pharmaceutical methods.
In Western countries, it is estimated that one-quarter of Pregnancy have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.
Induction of labor in those who are either at or after term improves outcomes for newborns and decreases the number of C-sections performed.
Mechanical and physical approaches can include artificial rupture of membranes or membrane sweeping. Membrane sweeping may lead to more women spontaneously going into labor (and fewer women having labor induction) but it may make little difference to the risk of maternal or neonatal death, or to the number of women having c-sections or spontaneous vaginal births. There are also risks associated with membrane sweeping. The risks include irregular contractions, bleeding, and in 1 out of every 10 women an amniotic sac rupture, which can lead to a formal induction within 24 hours of the rupture if labor hasn't been induced.
The use of intrauterine catheters are also indicated. These work by compressing the cervix mechanically to generate release on Prostaglandin in local tissues. There is no direct effect on the uterus. Results from a 2021 systematic review found no differences in cesarean delivery nor neonatal outcomes in women with low-risk pregnancies between inpatient nor outpatient cervical ripening.
Inducing labor before 39 weeks in the absence of a medical indication (such as hypertension, intrauterine growth restriction, or pre-eclampsia) increases the risk of complications of Preterm birth including difficulties with respiration, infection, feeding, jaundice, neonatal intensive care unit admissions, and perinatal death. Inducing labor after 34 weeks and before 37 weeks in women with pregnancy-related hypertensive disorders (pre-eclampsia, eclampsia, gestational hypertension) may lead to better outcomes for the woman but does not improve or worsen outcomes for the baby.
Postterm pregnancies lasting beyond 41-42 weeks are associated with increased risks of stillbirth, neonatal death and caesarean section which can be reduced by inducing labor.
If waters break (membranes rupture) between 24 and 37 weeks' gestation, waiting for the labor to start naturally with careful monitoring of the woman and baby is more likely to lead to healthier outcomes. For women over 37 weeks pregnant whose babies are suspected of not coping well in the womb, it is not yet clear from research whether it is best to have an induction or caesarean immediately, or to wait until labour happens by itself. Similarly, there is not yet enough research to show whether it is best to deliver babies prematurely if they are not coping in the womb or whether to wait so that they are less premature when they are born.
Sometimes when a woman's waters break after 37 weeks she is induced instead of waiting for labour to start naturally. This may decrease the risks of infection for the woman and baby but more research is needed to find out whether inducing is good for women and babies longer term.
Women who have had a caesarean section for a previous pregnancy are at risk of having a uterine rupture, when their Uterine niche re-opens. Uterine rupture is a serious threat for the woman and the baby, and induction of labour increases this risk further. There is not yet enough research to determine which method of induction is safest for a woman who has had a caesarean section before. There is also no research to say whether it is better for these women and their babies to have an elective caesarean section instead of being induced.
There is insufficient scientific evidence to determine if inducing a woman's labor at home is a safe and effective approach for both the woman and the baby.
Many women reported feeling that they were not involved in making the decision whether to induce labor and that this decision is made for them instead. Others reported feeling forgotten or alone in relation to the procedure, not being listened to and the severity of their pain being questioned. Some reported feeling they did not have a choice other than vaginal delivery but others reported being able to choose the date of induction and the method of giving birth.
Even though women reported seeing hospitals as a safe place for labor induction and giving birth, for some it is also considered an anxiety-inducing setting where they are restricted and not allowed to move around or see family members.
The medical rationale for performing an induction is decreasing the risk of stillbirth. However, the probability of having a stillbirth post-term is very small, meaning that for the vast majority of post-term pregnancies, inductions are unnecessary. Approximately 500 inductions are performed in order to avoid 1 stillbirth. Many of these unnecessary inductions could potentially provoke other risks, forcing medical practitioners to perform other interventions such as caesarean sections. These additional interventions could cause labor to be more risky for the pregnant person.
Another criticism of inductions is that the pregnant person's Bodily integrity is overlooked. Many pregnant people might not want to be induced, and rather share in the decision-making process with their medical practitioner.
Induced labor may be more painful for the woman as one of the side effects of intravenous oxytocin is increased contraction pains, mainly due to the rigid onset.National Institute for Health and Clinical Excellence, "CG70 Induction of labour: NICE guideline", July 2008, retrieved 2012-04-10 This may lead to the increased use of and other pain-relieving pharmaceuticals.Vernon, David, Having a Great Birth in Australia, Australian College of Midwives, 2005, These interventions may also lead to an increased likelihood of caesarean section delivery for the baby. However after 41 weeks of gestation there is a reduction of cesarean deliveries when the labour is induced.
The Institute for Safe Medication Practices labeled pitocin a "high-alert medication" because of the high likelihood of "significant patient harm when it is used in error."The Institute for Safe Medication Practices Results Of ISMP Survey On High-Alert Medications: Differences Between Nursing, Pharmacy, And Risk/Quality/Safety Perspectives ISMP.org. Retrieved 2017-01-09.
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